This ESRD facility monthly newsletter highlights the latest ESRD insights and resources. Our goal is to provide you with a resource that makes it easy for you to stay on top of trends and support you in providing the best possible care for those you work with and serve.
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In This Issue:
- News and Updates
- Make Your List and Check it Twice!
- Patient Services
- Cognitive Impairment
- Home Dialysis
- Why the First 90 Days Matter
- Hospital Admissions and ER Visits
- Reducing Missed Treatments - A Proactive Approach
- Transplant
- Dialysis Facility Transplant Waitlist Dashboard
- Vaccinations
- Flu & Pneumonia Season - Supporting and Protecting ESRD Patients
- EQRS
- Timely and Accurate CMS Form Submission
- Patient and Family Engagement
- Patient and Family Engagement in QAPI
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Make your list and check it twice!
The annual 2744 season is quickly approaching. If your facility is owned/managed by DaVita, DCI, Fresenius, Satellite, or USRC, you will soon receive instructions about the internal process for this from someone within your corporation. For all other facilities, please monitor your inbox for important emails from the Network about this process; right now, you can proactively prevent a long and painful review by balancing your internal roster with the EQRS roster, checking it once to make sure that all the patients on YOUR roster are on the EQRS roster, then checking it twice to make sure that all the patients on the EQRS roster are on your roster. If not, correct the error(s) so the rosters balance. If you need assistance with an issue, submit a ticket here.
Survey concerns
Some of you may not be aware that facility surveys begin with an email to the Network as required by the Core Survey Procedure manual. We work closely with Departments of Health as well as Accrediting Organizations. This month we wanted to share two survey pearls of wisdom.
The annual 2744 season is quickly approaching. If your facility is owned/managed by DaVita, DCI, Fresenius, Satellite, or USRC, you will soon receive instructions about the internal process for this from someone within your corporation. For all other facilities, please monitor your inbox for important emails from the Network about this process; right now, you can proactively prevent a long and painful review by balancing your internal roster with the EQRS roster, checking it once to make sure that all the patients on YOUR roster are on the EQRS roster, then checking it twice to make sure that all the patients on the EQRS roster are on your roster. If not, correct the error(s) so the rosters balance. If you need assistance with an issue, submit a ticket here.
Survey concerns
Some of you may not be aware that facility surveys begin with an email to the Network as required by the Core Survey Procedure manual. We work closely with Departments of Health as well as Accrediting Organizations. This month we wanted to share two survey pearls of wisdom.
- If you are unsure when your last facility survey was conducted and are curious about the date and findings, please review the annual Dialysis Facility Report, Table 13.
- Cleaning and disinfection of surfaces and equipment is the third most common citation within Networks 8 and 14. It may be helpful to remind staff about the importance of contact time as well as conducting periodic internal audits to stay survey ready.
- Contact Time: “After you apply disinfectant to a surface, leave the disinfectant on the surface long enough to kill the germs. This is called contact/wet time. You can find the contact time listed in the Data Safety Sheet and in the directions on the back of the disinfectant. The surface should stay wet during the entire contact time to make sure that germs are killed.” https://www.cdc.gov/hygiene/about/when-and-how-to-clean-and-disinfect-a-facility.html
- CDC Auditing Tools: “The Centers for Disease Control (CDC)’s Dialysis Safety Page contains several auditing checklists and assessment tools for dialysis care. Checklists include topics such as Catheter Care, Dialysis Station Disinfection, Hand Hygiene, etc. The Dialysis Safety Page also includes posters about infection prevention for both patients and providers. Resources can be found at this website link: https://www.cdc.gov/dialysis-safety/hcp/tools/index.html
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Cognitive impairment is a common complication among dialysis patients, affecting memory, attention, and treatment compliance. Warning signs include confusion during or after sessions, difficulty following instructions, mood changes, and frequent missed treatments or medication errors. Early recognition and intervention are essential for patient safety and quality of life.
Dialysis staff play a key role in observing subtle behavioral changes and ensuring timely assessments and interventions. Medicare patients can receive free cognitive screening during their annual wellness visit. It is important to document findings, communicate with the care team, and integrate cognitive status into treatment planning to provide individualized care. Offering support through simplified instructions, written materials, reminders, and connecting patients to resources such as support groups are vital steps toward improving outcomes and quality of life.
Dialysis staff play a key role in observing subtle behavioral changes and ensuring timely assessments and interventions. Medicare patients can receive free cognitive screening during their annual wellness visit. It is important to document findings, communicate with the care team, and integrate cognitive status into treatment planning to provide individualized care. Offering support through simplified instructions, written materials, reminders, and connecting patients to resources such as support groups are vital steps toward improving outcomes and quality of life.
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Why the First 90 Days Matter
The first 90 days of dialysis care set the foundation for long-term success. This period isn’t just regulatory—it’s a chance to improve outcomes and empower patients. Education must be ongoing; patients often retain little early on due to information overload, so reinforcement is critical.
The first 90 days of dialysis care set the foundation for long-term success. This period isn’t just regulatory—it’s a chance to improve outcomes and empower patients. Education must be ongoing; patients often retain little early on due to information overload, so reinforcement is critical.
Better Outcomes & Quality of Life
Repeated education helps patients choose the modality that fits their lifestyle. Home dialysis often means better blood pressure control, fewer hospitalizations, and greater independence.
Regulatory & Clinical Milestones
CMS requires an initial assessment within 30 days and a full care plan by 90 days, including modality education. Even for “crash starts,” this window is vital for screening depression, assessing quality of life, and confirming understanding—not just delivering information once.
Medical Director Leadership
Medical directors drive quality and shared decision-making. Their leadership ensures compliance and prioritizes home dialysis education, influencing both patients and staff.
Supports “Home First” Initiatives
National goals encourage starting home dialysis within 90 days. Early, reinforced training builds confidence and reduces long-term in-center dependence.
Patient Empowerment
Education means confirming comprehension. Informed patients feel more in control, less anxious, and more engaged, leading to better adherence and outcomes.
Your Challenge: Share these points with physicians during IDT meetings, rounds, or huddles. Review pages 4–5 of the Change Package for strategies. If physicians resist providing modality education, reach out. Together, we can make the first 90 days a solid foundation for better outcomes and patient confidence.
Repeated education helps patients choose the modality that fits their lifestyle. Home dialysis often means better blood pressure control, fewer hospitalizations, and greater independence.
Regulatory & Clinical Milestones
CMS requires an initial assessment within 30 days and a full care plan by 90 days, including modality education. Even for “crash starts,” this window is vital for screening depression, assessing quality of life, and confirming understanding—not just delivering information once.
Medical Director Leadership
Medical directors drive quality and shared decision-making. Their leadership ensures compliance and prioritizes home dialysis education, influencing both patients and staff.
Supports “Home First” Initiatives
National goals encourage starting home dialysis within 90 days. Early, reinforced training builds confidence and reduces long-term in-center dependence.
Patient Empowerment
Education means confirming comprehension. Informed patients feel more in control, less anxious, and more engaged, leading to better adherence and outcomes.
Your Challenge: Share these points with physicians during IDT meetings, rounds, or huddles. Review pages 4–5 of the Change Package for strategies. If physicians resist providing modality education, reach out. Together, we can make the first 90 days a solid foundation for better outcomes and patient confidence.
Resources: A Change Package to Increase Home Dialysis Use
Home Dialysis Contact: katherine.buntin@allianthealth.org
Home Dialysis Contact: katherine.buntin@allianthealth.org
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Reducing Missed Treatments - A Proactive Approach
Missed treatments pose a significant challenge and addressing them proactively can make a meaningful difference.
Missed treatments pose a significant challenge and addressing them proactively can make a meaningful difference.
Our goal is to help patients understand their condition and feel supported in making healthy choices, including attending all prescribed treatments.
The first 90 days of dialysis are critical for habit formation. Setting clear expectations from day one and reinforcing them consistently helps patients stay on track with their treatment plan. Creating a positive clinic culture around attendance promotes better health and reduces unnecessary hospitalization.
Shifting the conversation from “nonadherence” to “healthy living” fosters trust and openness. Patients respond better to positive, caring communication. The Network offers resources to help educate and encourage healthy lifestyles.
Practical Strategies:
The first 90 days of dialysis are critical for habit formation. Setting clear expectations from day one and reinforcing them consistently helps patients stay on track with their treatment plan. Creating a positive clinic culture around attendance promotes better health and reduces unnecessary hospitalization.
Shifting the conversation from “nonadherence” to “healthy living” fosters trust and openness. Patients respond better to positive, caring communication. The Network offers resources to help educate and encourage healthy lifestyles.
Practical Strategies:
- Implement and strengthen facility protocols for missed treatments.
- Involve the Charge Nurse and Clinic Manager when a patient cancels or misses.
- Offer flexible scheduling options when possible.
- Keep a chair open for extra treatments.
- Educate patients regularly on the risks of missing treatments.
- Recognize and reward consistent attendance.
Resources:
- Missing Dialysis
- Missed Treatments Word Search Holiday Edition (English) (Spanish)
- NW 8 & 14 When Patients Don't Come to Dialysis
The Dialysis Facility Transplant Waitlist Dashboard, located in EQRS, displays UNOS data for all your waitlisted patients, including waitlist dates, waitlist status, removal reasons and dates, and transplant center listings.
Reviewing your transplant waitlist data in EQRS monthly will help your facility:
- Track your patient’s waitlist status in real time.
- Compare waitlist data with your facility internal records to avoid discrepancies.
- Identify status changes and reasons promptly.
- Supportpatients in staying active and ready for transplant.
- Use the download csv feature to export data and integrate it with your internal tracking tools for streamlined monitoring and follow-up.
Resource: Transplant Waitlitst Dashboard for Dialysis Facilities
Transplant Contact: arlandra.taylor@allianthealth.org
Transplant Contact: arlandra.taylor@allianthealth.org
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Flu & Pneumonia Season - Supporting and Protecting ESRD Patients
Flu and pneumonia remain leading causes of hospitalization for ESRD patients during the winter months.
Flu and pneumonia remain leading causes of hospitalization for ESRD patients during the winter months.
While staff are well-versed in clinical management, patients sometimes struggle to recognize symptoms early or understand the importance of prevention and early intervention. Reinforcing these messages can make a measurable difference in outcomes.
Key Focus Areas for Facilities:
Key Focus Areas for Facilities:
- Educate Patients on Symptoms:
- Flu: sudden fever, chills, muscle aches, cough, sore throa
- Pneumonia: cough with phlegm, chest pain, shortness of breath, confusion (especially in older adults)
- Promote Vaccination Uptake
- Reinforce education and provide strong recommendation for annual flu shots and pneumococcal vaccines.
- Reinforce Prevention Habits
- Hand hygiene, masking during peak season, and avoiding close contact with those who are sick can protect both patients and staff.
- Encourage Early Symptom Reporting
- Remind patients to alert staff quickly when symptoms arise, so interventions can begin early.
Resources: Pneumonia Zone Tool (English) (Spanish)
Vaccination Contact: hayley.errington@alllianthealth.org
Vaccination Contact: hayley.errington@alllianthealth.org
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Timely and Accurate CMS Form Submission
Each facility should regularly review the Form 2728 and 2746 dashboard tab within EQRS—ideally no less than once per week and preferably twice per week for facilities open six days per week. This dashboard provides one-year cumulative data showing how many forms were submitted on time and can help ensure your clinic remains compliant with CMS requirements, as well as maintaining proper management oversight of the required forms.
Key features of the dashboard:
Each facility should regularly review the Form 2728 and 2746 dashboard tab within EQRS—ideally no less than once per week and preferably twice per week for facilities open six days per week. This dashboard provides one-year cumulative data showing how many forms were submitted on time and can help ensure your clinic remains compliant with CMS requirements, as well as maintaining proper management oversight of the required forms.
Key features of the dashboard:
- Displays submission timeliness for Forms 2728 and 2746.
- Shows all submission dates and due dates within the selected timeframe to audit form submission rates.
- Allows data export for internal review and tracking.
- Form 2728: Must be submitted within 45 days.
- Form 2746: Must be submitted within 14 days.
Resources: 2728 and 2746 Data Dashboard Instruction
EQRS Data Quality Contact: grace.robbins@allianthealth.org
EQRS Data Quality Contact: grace.robbins@allianthealth.org
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Patient and Family Engagement
Why It Matters:
Research shows that when patients actively participate in their healthcare, safety and quality improve significantly. The voice and ideas of patients help shape better care by influencing planning, delivery, and evaluation.
Areas Where Patients Can Make a Difference
Research shows that when patients actively participate in their healthcare, safety and quality improve significantly. The voice and ideas of patients help shape better care by influencing planning, delivery, and evaluation.
Areas Where Patients Can Make a Difference
- Patient Concerns: Diet and nutrition, fluid management, satisfaction or grievances, personal health goals, scheduling flexibility.
- Clinical Care: Nutritional status, vascular access, preventing medical injuries, infection control.
- Facility Management: Emergency preparedness, education on home dialysis and transplant options, fistula, and catheter care.
- Chairside Conversations: Discuss non-urgent issues during QAPI meetings and follow up with results.
- Join Virtually: Participate via conference call if you can’t attend in person.
- Suggestion Box: Keep paper and pencil nearby; review submissions and post responses for transparency.
- Patient Representative: Use your Facility Patient Representative to gather and share ideas from fellow patients.
Patient and Family Engagement Contacts:
Network 8: casey.rich@allianthealth.org
Network 14: ericka.webb@allianthealth.org
Network 8: casey.rich@allianthealth.org
Network 14: ericka.webb@allianthealth.org
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Our mailing address is:
ESRD Networks 8 & 14
P.O. Box 105337
Atlanta, GA 30348